can cpt code 63030 and 63047 be billed together

Since clinical documentation details both a laminectomy

and a laminotomy being performed on different levels of the spine with medical necessity clearly defined, both CPT code 63030 (L1 HNP) and 63047 (L2 spinal stenosis) may be reported with the appropriate modifier.

Full Answer

Is CPT code 63047 the same as 22633?

It has always been the position of AANS that CPT coding descriptions of these codes allow for reporting of 63047 at the same level as 22633 or 22630 when work for decompression of neural elements is required in addition to the work required to perform the interbody fusion.

What is the difference between 63047 and 63030?

Code 63030 is a column 2 code for 63047 , but a modifier is allowed in order to differentiate between the services provided. Note*: Always use modifier (if allowable) with column 2 code.

When to add a-59 modifier to a CPT 63047?

The need for decompression for clinical scenarios such as neurogenic claudication alongside the need for interbody fusion, such as instability, must be accurately documented in the operative note. Based on this CPT Assistant publication, a -59 modifier should be added to 63047 when used with the 22633 or 22630 for non-Medicare patients.

When to use CPT code 63047 for lateral recess decompression?

It should only be used after the global period for the first disc surgery lateral recess decompression at a level CPT code 63047 if no disc work is per- formed. The presence of a lumbar disc herniation (722.1) drives the CPT code. Another common misconception is code 63047.

What is the difference between CPT code 63047 and 63030?

Or should a second primary code (63030) be reported for the diskectomy at L5-S1? A: These procedure codes are directly related to the diagnosis. CPT code 63047 is reported for the surgery at L4-5 linked to the stenosis diagnosis. CPT code 63047 is a unilateral/bilateral code and is reported one time per lumbar level.

Does CPT 63030 need a modifier?

As to CPT 63030, claimant supplies NCCI materials that support the primary code CPT 63047 (highest value procedure) in column 1 lists CPT 63030 in column 2 with an inidcator of “1” and thus, requiring a modifier. This would be the same for CPT 63048 and the corresponding additioanl level of 63035.

Can CPT code 63047 and 63048 be billed together?

Use CPT 63045 for cervical or CPT 63047 for lumbar, with additional levels billed with add-on Code +63048 unilateral or bilateral. In this procedure, the physician removes the spinous process. If the stenosis is central, the lamina may be removed out to the articular facets using a burr.

Can CPT code 63042 and 63047 be billed together?

CMS payment policy does not allow separate payment for CPT codes 63042 (laminotomy...; lumbar) or 63047 (laminectomy...; lumbar) with CPT codes 22630 or 22633 (arthrodesis; lumbar) when performed at the same interspace.

What is the CPT code 63030?

CPT® Code 63030 in section: Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc.

What is the difference between 63030 and 63042?

So 63042 is used for revision discectomies. And 63030, in addition to describing laminotomies performed with a discectomy to treat spinal disc herniation using an open procedure, can also describe those performed under endoscopic assistance.

What is procedure code 63047?

CPT® Code 63047 in section: Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment.

Can CPT code 22630 and 63047 be billed together?

A: This is probably the biggest controversy in CPT spinal fusion coding. First of all, CPT 63047 does not bundle with 22612, so that's an easy yes, you can bill both. The issue is that CPT 63047 bundles with both 22630, 22633.

Can 63047 and 63056 be billed together?

It can not be billed with either one ever.

Is laminectomy the same as decompression?

Laminectomy (removal of lamina bone) and diskectomy (removing damaged disk tissue) are both types of spinal decompression surgery. Your provider may perform a diskectomy or other techniques (such as joining two vertebrae, called spinal fusion) during a laminectomy procedure.

What is the difference between a laminectomy and a laminotomy?

The procedures In a laminotomy, your doctor makes a hole in the lamina and removes a small piece of the bone. In a laminectomy, your doctor removes most of the bone.

What is the CPT code for lumbar discectomy?

Lumbar Discectomy/Microdiscectomy procedure 62380 Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar.

Does 73030 need a modifier?

CPT code 73030 has both a technical and professional component. It is appropriate to attach TC with technical components and 26 with the professional component. Submit without a modifier to bill the complete procedure (i.e., professional and technical features).

Can CPT code 97530 and 97140 be billed together?

You will not be able to use a 59 modifier to charge 97530 with an initial evaluation. Note that you can continue to bill other timed codes, such as 97110, 97112 and 97140 with an initial evaluation. However, you will now be required to use a 59 modifier if you bill 97140 (manual therapy) with an initial evaluation.

When should CPT code 76000 be used?

CPT® fluoroscopy codes 76000 (up to 1 hour physician time) and 76001 (physician time greater than 1 hour) are intended for use as stand-alone codes when fluoroscopy is the only imaging performed.

Are all CPT codes 5 digits?

All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm.

What is 63047?

63047 – Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root [s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar – average fee amount – $1100 – $1200

What is the CPT code for PLIF?

The new CPT code for use instead for the PLIF Posterior Lumbar Interbody Fusion procedure for 2012 would now be 22633 for an Arthrodesis, combined Posterior or Posterolateral Technique with Posterior Interbody Technique, including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment;

What is the code for arthrosis?

The 22610 code for an Arthrodesis (Fusion) using the Posterior or Posterolateral Technique, single level; Thoracic now states this code is done WITH the Lateral Transverse Technique (the code previously stated with or without).

Is 63047 an add on code?

Anthem Central Region bundles 63047 and 63048+ as incidental with 22630. Based on the Complete Global Service Data for Orthopaedic Surgery, CPT code 22630, code 63047 is listed as a service that is included when performing 22630. Based on the National Correct Coding Initiative Edits, code 63047 is listed as a component code to code 22630. Since 63048 is an add on code that only may be reported along with 63047, 63048 follows the same rationale that is used with 63047. Therefore, if 63047 and 63048+ are submitted with 22630—only 22630 reimburses

Does 63042 bundle with 22630?

Anthem Central Region does not bundle 63042 with 22630, does not bundle 63042-50 with 22630, does not bundle 63042-LT with 22630 and does not bundle 63047-RT with 22630. Based on the Complete Global Service Data for Orthopaedic Surgery, CPT Code 22630, code 63042 is not listed as a service that is included when performing 22630. Based on the National Correct Coding Initiative Edits, code 63042 is not listed as a component code to code 22630. Therefore, if 63042 is submitted with 22630—both services reimburse separately, if 63042-50 is submitted with 22630—both services reimburse separately, if 63042-LT is submitted with 22630—both reimburse separately and if 63042-RT is submitted with 22630—both services reimburse separately.

Is 63035 a component code?

Based on the National Correct Coding Initiative Edits, code 63035 is not listed as a component code to code 63043. Based on the 2004 CPT manual code 63035+ is an add on code and is to be used in conjunction with codes 63020 and 63030.

Is 63030 a part of 63044?

Anthem Central Region does not bundle 63030 with 63044+. Based on the Complete Global Service Data for Orthopaedic Surgery manual, code 63030 is not listed as a service that is included or not included in the global Service of CPT Code: 63044. Based on the National Correct Coding Initiative Edits, code 63030 is not listed as a component code to code 63044. Therefore, if 63030 is submitted with 63044—both reimburse separately.

What is CPT 63030?

CPT 63030, Laminotomy (hemilaminectomy), with decompression of nerve root (s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar (including open or endoscopically-assisted approach) normally bundles into 63047, Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root (s) (e.g. spinal or recess stenosis), single vertebral segment, lumbar. When determining separate reporting, ask the following: 1 Does the specific carrier or Medicare edits allows for a modifier to be appended? 2 If the specific carrier or Medicare edits allows a modifier, is the service separate and distinct from the primary procedure in this instance with clinical/op documentation describing the additional procedure in detail? 3 Is Medical necessity supported for the additional procedure to have been performed?

What is the CPT code for laminectomy?

Since clinical documentation details both a laminectomy and a laminotomy being performed on different levels of the spine with medical necessity clearly defined, both CPT code 63030 (L1 HNP) and 63047 (L2 spinal stenosis) may be reported with the appropriate modifier.

Is CPT a trademark?

CPT copyright 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Is CPT 63030 on the ASC list?

Reimbursement note: While Medicare edits allows separate reporting of these procedures when clinically indicated, neither CPT 63030 nor CPT 63047 are found on Medicare's ASC approved list of surgical procedures. This does not preclude that all commercial carriers follow Medicare's footsteps. Verify reporting/reimbursement policies for all carriers prior to performing these procedures at your facility.

What is the CPT code for lumbar decompression?

Common areas of confusion include CPT code 63042. Re-exploration at a level with a recurrent disc herniation can only use CPT code 63042. It should only be used after the global period for the first disc surgery has expired. Repeat facetectomy and lateral recess decompression at a level with a prior decompression must use CPT code 63047 if no disc work is per-formed. The presence of a lumbar disc herniation (722.1) drives the CPT code.Another common misconception is code 63047. This code can be used unilaterally or bilaterally as long as the decompression involves the lateral recess and foramen. Posterior fusion codes that involve disc preparation (22630,22633) already take into account the decompression work. Using ad-ditional decompression codes (63005, 63012, 63030,63042, 63047) is not al-lowed.

What is the 2014 coding scenario?

2014 Common Coding Scenarios for Comprehensive Spine Care includes medical and surgical coding vignettes, key components to include in the procedure notes and proper coding of spine procedures for 2014.

What modifier should be added to 63047?

Based on this CPT Assistant publication, a -59 modifier should be added to 63047 when used with the 22633 or 22630 for non-Medicare patients.

Can you apply the same CPT codes differently for operative procedures that are identical?

Applying the same CPT codes differently for operative procedures that are identical has the potential to cause confusion. The AANS Coding Courses add greater clarity to the lumbar decompression and interbody codes and other coding challenges.

Is 63047 the same as 22630?

It has always been the position of AANS that CPT coding descriptions of these codes allow for reporting of 63047 at the same level as 22633 or 22630 when work for decompression of neural elements is required in addition to the work required to perform the interbody fusion. The need for decompression for clinical scenarios such as neurogenic claudication alongside the need for interbody fusion, such as instability, must be accurately documented in the operative note.

Does Medicare allow payment for both services?

Medicare, via the National Correct Coding Initiative (NCCI) edits, communicated that this code combination, when reported together for work at the same level during the same operative session by the same surgeon, will consider the services inclusive and will not allow payment for both services.

Does Medicare report laminectomy work?

Medicare considers the work of the laminectomy and decompression to overlap with the work that is valued into the interbody fusion. While CPT states the two are reportable when the work is over and beyond the work of the discectomy, CMS does not consider the work at the same level overlapping.